Provider Demographics
NPI:1841415635
Name:COMMUNITY HEALING CENTER
Entity type:Organization
Organization Name:COMMUNITY HEALING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PIOCH
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:269-343-1651
Mailing Address - Street 1:1225 S 11TH STREET
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-3408
Mailing Address - Country:US
Mailing Address - Phone:269-684-7741
Mailing Address - Fax:269-684-3671
Practice Address - Street 1:1225 S 11TH STREET
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-3408
Practice Address - Country:US
Practice Address - Phone:269-684-7741
Practice Address - Fax:269-684-3671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI110082261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder